BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 161 (Huff)
Hearing Date: 05/26/2011 Amended: 05/17/2011
Consultant: Jacqueline Wong-HernandezPolicy Vote: Education 6-1,
Health 7-0
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BILL SUMMARY: SB 161 would authorize a school district to
provide school employees with voluntary emergency medical
training to provide, in the absence of a nurse, to provide
emergency medical assistance to pupils with epilepsy suffering
from seizures, according to specified guidelines. This bill
would allow the parent/guardian of a pupil who has been
prescribed an emergency antiseizure medication, as defined, to
request the pupil's school have one or more employees receive
voluntary training to administer the medication. This bill
outlines notification and training procedures for school
districts and employees that elect to provide this training and
authority. This bill encourages the Epilepsy Foundation of
America to develop guidelines for the training and supervision
of school employees in providing emergency medical assistance,
as specified, and authorizes the California Department of
Education (CDE) to include on its website a clearinghouse of
best practices for training nonmedical personnel to administer
emergency antiseizure medication. This bill makes legislative
findings and declarations.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
DPH guidelines Potentially significant
one-time costs General
CDE consultation Likely minor
one-time costs General
CDE website information --- Minor and
absorbable --- General
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SB 161 (Huff)
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STAFF COMMENTS: SUSPENSE FILE.
Under existing law, the Nursing Practice Act sets forth the
scope of practice for nursing, which specifically includes the
administration of medication, and prohibits any person from
engaging in the practice of nursing without a license. Current
law authorizes non-medical school personnel to administer
certain medications (epinephrine auto-injectors, glucagon) to a
pupil in an emergency, as specified. Current law allows
non-medical school personnel to assist or administer medication
to a pupil on a routine basis in certain cases, regarding
epinephrine, inhaled asthma medication, or in cases where the
pupil's health care provider gives a written statement with
specific information, such as the medication the pupil is to
take, the dosage, and the period of time during which the
medication is to be taken, and if the pupil's parent provides a
written statement initiating a request to have the medication
administered to the pupil or to have the pupil otherwise
assisted in the administration of the medication.
This bill would authorize a school district to provide school
employees with voluntary training for the provision of emergency
medical assistance to certain pupils suffering from an epileptic
seizure, in accordance with "a training plan approved on the
department's Internet Web site" and to "the performance
instructions set forth by the licensed health care provider of
the pupil." The bill provides that the parent of a pupil that
is prescribed emergency antiseizure medication may request the
school to have one or more employees trained to administer the
drug when a nurse is not available. Upon receipt of the request,
the school would be required to notify the parent that the pupil
may qualify for a Section 504 plan (under the federal
Rehabilitation Act of 1973) and can be assessed at the parent's
request.
If the parent does not choose to have the pupil assessed for a
504 plan, the school may opt to create an individualized health
plan to prepare to meet the pupil's needs. If the school
district had chosen to allow participation, a school under its
jurisdiction may solicit volunteers to be trained to administer
emergency antiseizure medication in the absence of licensed
professional, as specified. If there are no volunteers, the
school would re-notify the parent of the option to be assessed
for a 504 plan, pursuant to federal law.
SB 161 (Huff)
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The school plan would include the identification of existing
licensed personnel that could be trained to administer the
medication, identification of pupils who may require the
administration, written authorization from the parent that
nonmedical personnel may administer the emergency antiseizure
medication to the pupil, and a written statement from the
pupil's health care practitioner specifying the proper dosage,
appropriate time for administration, and other specified
protocols. While this bill specifically provides for school
districts to decide whether or not to provide this training (and
thus, participate), it is unclear whether a school
administrator, upon receiving a request, could decide whether
his or her school would participate in seeking and providing
specified volunteers.
This bill specifies that an individual who has volunteered to
administer emergency antiseizure medication may rescind his or
her offer to do so with a two-week notice, as specified. It is
unclear what the consequences of violating this provision would
be. If a volunteer were, for example, to decide to that he or
she did not feel comfortable administering the medication in a
moment of necessity, it is unclear what would happen.
Participating schools would be required to provide
indemnification and legal defense for volunteers for actions
they volunteered to take on, but it is unclear whether that
would be provided if a volunteer decides not to perform
activities for which he or she was trained and which were part
of a pupil's seizure plan at the school.
Any costs incurred by the district for the training of personnel
and administration of the drug would be at local discretion or
pursuant to Section 504, so there should be no increase in state
costs for those activities. To the extent that a voluntary
process is successfully implemented as an alternative to a
likely more expensive Section 504 accommodation, there may be
significant local savings for schools with pupils who have been
prescribed emergency antiseizure medication.
This bill encourages the Epilepsy Foundation of America
(Epilepsy Foundation) to develop guidelines for the training and
supervision of school employees in providing emergency medical
assistance to pupils with epilepsy suffering from seizures, and
provides that the guidelines may be developed in cooperation
SB 161 (Huff)
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with the State Department of Education, the California School
Nurses Organization, the California Medical Association, and the
American Academy of Pediatrics. Upon development of the
guidelines, the CDE is authorized to review and approve them for
distribution and to make those guidelines available upon
request. The CDE is also permitted to post guidelines and a
clearinghouse of best practices.
This bill specifically provides that volunteers will follow a
training plan posted on the CDE website. Thus, implementation
presumes that these permitted activities (involving both the
Epilepsy Foundation and the CDE) will occur. As drafted, this
bill's implementation could be delayed or stopped by the
foundation or CDE's decisions and time tables for completing
voluntary activities. CDE participation in developing and
approving training guidelines could result in significant costs
to the department, depending on its level of participation and
the extent of the guideline development process. This process is
likely to be complex and potentially contentious, depending on
the stakeholders involved. Requiring CDE participation in order
to implement the voluntary provisions of this bill creates cost
pressure to the CDE to review and approve guidelines. This would
likely involve significant staff time for existing departmental
staff, and could require contracting a part-time nurse or other
medical professional to advise CDE in its approval process. The
CDE has indicated it will submit a Budget Change Proposal
requesting an additional position should it determine one is
necessary to implement this provision.
Staff notes that while litigation costs are not typically
considered in this committee, this bill is likely to invite
litigation against the CDE if guidelines are approved and posted
for administering specified antiseizure medication. Similar
scope of practice issues are currently being litigated between
the American Nurses Association and the CDE, with regard to
administering insulin injections. American Nurses Association v.
Jack O'Connell, Superintendent of Public Instruction and
American Diabetes Association is before the California Supreme
Court, and the CDE expects the case will be decided late this
year.
As proposed to be amended: Require the Department of Public
Health, in consultation with the Department of Education to
develop guidelines. Specify restrictions volunteer solicitation.
SB 161 (Huff)
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